Published in RINewsToday on March 25, 2024
A few weeks ago, advocates for seniors gathered on Smith Hill, attending a Senate Committee on Health & Human Services hearing to push for passage of S. 2399. The legislation would expand income eligibility for the Medicare Savings Program (MSP), helping many lower income seniors and disabled residents pay their $175/month Medicare Part B premium and covering co-pays and deductibles for those with very low-income.
Thousands of low-income seniors and persons with disabilities on Medicare, but not eligible to participate in the state’s Medicaid program, struggle to pay their Medicare Part B premiums and co-pay costs for services and prescription drugs causing many to forgo needed health care as they cannot afford to pay the co-payments.
S. 2399, introduced by Pawtucket Sen. Sandra Cano (D-Dist. 8, Pawtucket), would expand eligibility for the Medicare Savings Program (MSP) by increasing the income limit to 186% of the federal poverty line and eliminating the strict asset limit. It also increases from 100% to 138% of the federal poverty line a part of the program that covers deductibles and co-payment.
S. 2399 was heard on March 12, 2024 and held for further study. At press time, H. 7333, introduced by Pawtucket Rep. Karen Alzate (D-Dist. 60, Pawtucket, Central Falls), has been referred to the House Finance Committee for consideration. No hearing date has been scheduled.
“With health care costs rising at an alarming rate, it is imperative that we make sure that no one goes without the care they need due to unaffordability. This bill adapts to the significant changes in our society and economy while also ensuring that our most vulnerable senior and disabled residents are able to access the care and medicine that is essential to their daily lives,” said Cano, who champions S. 2399 and in previous legislative sessions introduced legislation to expand the MSP.
“Too many of our low-income seniors and disabled residents are falling through the cracks and foregoing crucial health care services due to rising co-pays and out of pocket costs. This is unacceptable, but thankfully, we can do something about it. By passing this legislation, thousands or more Rhode Islanders will be able to receive the care that they desperately need while also keeping more money in their pockets that’s needed for daily living expenses,” said Alzate, who sponsored the House companion measure.
“We understand this is very important legislation. We had a very informative, thorough hearing on this bill, and I look forward to reviewing all the information we collected.” says Senate Health and Human Services Committee Chairman Joshua Miller (D-Dist. 28, Cranston, Providence).
The Policy Problem and its Solution
Currently, the income limit of $20,331 leaves thousands of older Rhode Islanders and disabled low-income persons on Medicare with significant gaps in coverage and hefty out of pocket costs.
If the MSP income limit is increased to $28,012, as required by the legislation, an estimated 17,000 persons would be newly eligible to have their Medicare Part B covered by being enrolled in MSP. Anyone enrolled in the MSP receives automatic enrollment in Part D “Extra Help,” a federal program which significantly lowers out-of-pocket Medicare prescription costs at no cost to the State. The federal government establishes the minimum income and asset thresholds for the MSP, and states are permitted to increase these limits and many have done so.
Advocates of Cano’s MSP legislative proposal say it also particularly helps Rhode Island’s older woman and minorities. “Since women and people of color and persons with disabilities are disproportionately represented in low-income populations, increasing access to the MSP promotes equity,” finds an advocacy partnership’s analysis of the legislative proposals. “Poverty rates among older adult Hispanic women are two and one-half times that of older Hispanic men and persons age 18 and over with disabilities are twice as likely to live below 150% of the poverty level, said the analysis.
The advocacy partnership’s analysis also noted that significant numbers of older adults and those with disabilities enrolled in Medicare face financial challenges meeting basic needs. The number of older adults living below or near poverty has increased, housing costs have climbed dramatically, food cost have increased and many more rely on food pantries.
Covering the $175/month Medicare Part B premium for 17,000+ Rhode Islanders (at no cost to the State) and additionally covering co-pays and deductibles for thousands of very low-income adults and persons with disabilities on Medicare will give them much needed financial relief. And enrollment in the Extra Help program to reduce drug-related costs provides significant additional financial assistance and improves access to critical medication.
Testimony At the Senate Committee Hearing
Nine organizations either testified at this hearing or submitted written testimony to urge passage of S. 2399. AARP Rhode Island did not testify at the hearing but signed up in support in the committee room. There was no opposition to Cano’s legislative proposal.
“I first became aware of the need to expand the income eligibility for MSP quite a few years ago when an older man in my neighborhood contacted me to tell me he lost out on the program because he was just a few dollars over the income limit. As a result, the Senior Agenda Coalition of RI (SACRI) has advocated for several years to increase the income cap,” says Maureen Maigret, SACRI’s policy Advisor.
It’s a win-win for both older Rhode Islanders and for the Rhode Island General Assembly, says Maigret. “S. 2399 would help Medicare beneficiaries to access care along with putting money back in their pockets to pay for food, rent and their basic needs. By increasing the Medicaid income to $28,012, the federal government will pay the full cost of the newly eligible Medicare beneficiaries,” she told the lawmakers.
Strongly supporting S2399, Karen Malcolm, of Protect Our Healthcare Coalition, noted that the legislative proposal is modeled on the MSP changes enacted in New York last year and approved by the Centers for Medicare and Medicaid Services. “Rhode Island should take advantage of the opportunity to expand access to affordable coverage for seniors and people with disabilities and bring new [federal] revenue to our state.”
H. Phillip West, Jr. lobbyist for the Village Common of Rhode Island, states MSP already makes an enormous difference for many beneficiaries. But, “Rhode Island’s low threshold for eligibility and low allowable assets leaves thousands of our needy neighbors out. The good news is that Senator Cano’s legislation address these defects,” he said.
In submitted written testimony, Heather Smith, MD, president of the Rhode Island Medical Society stated “From our perspective as physicians, we witness firsthand the adverse effects of financial barriers on patient health outcomes. Too often, individuals are forced to forgo or ration medications, delay necessary treatments, or skip preventative care due to concerns of affordability. These delays can exacerbate health conditions, lead to complications, and ultimately result in higher healthcare costs down the road.”
Alex Moore, political director of SEIU 1199NE, stressed the many benefits of passing S. 2399, specifically enhancing access to care, providing needed financial relief, leveraging federal funds, and strengthening the health care workforce. By supporting the legislative proposal, “we demonstrate our commitment to health and well-being of our state’s most vulnerable populations,” he stated in written testimony.
Even with the strong support of the aging community, the state’s Office of Healthy Aging has not yet taken an official position on S. 2399. “As with any other bills at this stage of the session, we are reviewing the impact of H 7333 and S 2399 on Rhode Islanders. We will continue to follow these bills as they make their way through the legislative process,” says Director Maria Cimini.
Samuel Salganik, JD, executive director of RIPIN, which offered testimony in support for S.2399, said, “This is one of the best investments available right now for our state government. At a cost of just over $5 million, the State can draw down more than $40 million in federal support to assist low-income seniors in Rhode Island,” says Salganik. “It’s a great deal for the state. I think that’s a deal that most of us would happily take,” adds Salganik.
Gov. Dan McKee’s recently released FY 2024 Budget does not include funding for to expand the state’s MSP. Now the ball is in House Speaker Joseph Shekarchi’s (D-Dist. 23, Warwick) court as his chamber collaborates with the Senate to hammer out budget resolution to be approved by the Rhode Island General Assembly to be sent for the Governor’s signature. Hopefully, Shekarchi will see the expansion of the state’s MPM as a win-win for lower-income and disabled persons on Medicare and the state. As supporters of S 2399 and H 7333 say, “it’s a no brainer.”
The Advocacy Partners for MSP Expansion was established to push for the passage of S 2399 and H 7333 during this legislative session. They are: the Senior Agenda Coalition of Rhode Island, Rhode Island Organizing Project, RIPIN, the Economic Progress Institute, the Protect Our Healthcare Coalition and the Ocean State Center for Independent Living.
To access the bills under consideration: http://webserver.rilegislature.gov/BillText/BillText24/SenateText24/S2399.pdf – http://webserver.rilegislature.gov/BillText/BillText24/HouseText24/H7333.pdf
Expanding the income eligibility for the Medicare Savings Program (MSP) is one of the legislative priorities of the Senior Agenda Coalition of Rhode Island. These policy issues will be discussed at its upcoming Legislative Leaders Forum scheduled on Wednesday, March 27, 2024, from 10:00 a.m. to 11:00 a.m., at the Crowne Plaza Hotel, 601 Greenwich Ave,, Warwick, RI.
The Senior Agenda Coalition of RI’s Annual Legislative Leaders Forum is this week:
Tag Archives for Rhode Island General Assembly
The RI Budget proposal, as seen by our fastest growing demographic, Seniors
Published in RINewsToday on January 22, 2024
This Tuesday, Jan. 16th, Governor Dan McKee officially kicked off the legislative debate on the state’s $13.68 billion FY 2025 Budget in his 48 minute (4,481 word) State of the State address that laid out his spending priorities.
Over the next six months the General Assembly will hold hearings on the proposed budget blueprint, rewriting it considering state revenues identified during the May Revenue and Caseload Estimating Conferences, and priorities of the legislature.
With passage by the House and Senate and signed into law by McKee, the final FY 2025 Budget will take effect July 1.
Governor McKee’s budget proposal, which came 2 days after the State of the State, makes funding investments in education, small business, and Rhode Island’s health care system without raising any broad-based taxes. FY 2025 Budget specifics can be found in an article published by RINewsToday on Friday, Jan. 19th – HERE.
With the official release of McKee’s 2025 budget proposal on Thursday afternoon, Jan. 18, his statement along with comments from the top House and Senate legislative leaders were quickly issued.
“The Team Rhode Island budget that I’m sending to the General Assembly today prioritizes programs and initiatives that will help raise the incomes of our fellow Rhode Islanders,” said McKee.
“By using available resources in targeted and strategic manner, we will continue to make progress on our RI 2030 goals while putting Rhode Islanders to work in good-paying jobs on projects that will pay dividends for decades to come,” he adds.
Legislative leadership
“Over the next several months, Chairman Lou DiPalma and the Senate Finance Committee will conduct a rigorous review of all aspects of the proposed budget through their public hearing process. At this early stage, I am pleased that the budget proposal reflects some of the Senate’s top priorities, including moving our state towards universal public pre-kindergarten, increasing funding for multi-language learners, increasing access to no-cost meals for students, fully funding recommended reimbursement levels for Early Intervention and increasing Medicaid rates,” says President of the Senate Dominick J. Ruggerio.
“Now that Governor McKee has submitted the budget, our robust review process will begin. Chairman Marvin Abney and the House Finance Committee will soon commence the public hearing process and we look forward to working collaboratively with the Senate and Governor McKee over the next several months. With the federal pandemic funds having been allocated, we must live within our means and carefully scrutinize all spending requests,” says House Speaker K. Joseph Shekarchi. “The Senate will continue working with all partners and stakeholders to adopt a budget that meets the needs of all Rhode Islanders.” adds the Senate President.
Aging Groups and Advocates share thoughts
“It was good to see attention to older adults’ financial security by the proposal to increase the amount of pension income that can be exempted from state income taxes which would bring an estimated $500 benefit to about 10,000 persons,” says Maureen Maigret, The Senior Agenda Coalition’s policy advisor and former Director of the RI Department of Elderly Affairs.
“The Governor is looking for ways to increase Rhode Islanders’ incomes and the Senior Agenda Coalition has been working with several partners on a legislative proposal that would save $2,000 a year for many thousands of lower-income older persons and persons on disabilities on Medicare by having the federal government pay the cost of their Part B premiums,” she says, noting that this policy would not only save seniors money they can use for basic living expenses, but would bring millions of dollars into the state economy. It would also make them eligible for a federal program that helps pay for prescription drugs.
“We hope the $10 million in proposed bridge funding for nursing homes will help them to continue to provide necessary services for their vulnerable populations and avoid more closures which are so traumatic for residents,” says Maigret.
“Although welcome, we had been hoping for more than the modest increase of $200,000 for senior centers as it gets distributed across around 40 senior centers. We know our older population is growing and our senior centers help hundreds of older adults stay healthy and connected to their communities,” adds Maigret.
“With many older adults waiting three months or more to get home care services and the home care worker shortage continuing it is disappointing to see the reimbursement increases recommended by the Social and Human Service Rate Review Study spread out over three years especially when the Executive Office of Health and Human Services had recommended funding the recommended increases over two years. And home care is not only what persons say they prefer but it costs far less to state government than institutional care,” notes Maigret.
“AARP Rhode Island applauds the Governor’s goal of increasing financial security for all Rhode Islanders,” said AARP Rhode Island State Director Catherine Taylor in a statement released days before the release of McKee’s budget blueprint. “Everyone should be able to choose how they live as they age,” she says.
AARP Rhode Island calls on the General Assembly to pass three pieces of legislation that would help to ensure financial security for all. AARP Rhode Island is pushing lawmakers to give all Rhode Islanders access to a retirement savings vehicle. We are pleased that Governor McKee called for the passage of the Secure Choice program, which would provide an optional, voluntary Roth-IRA plan to the 172,000 Rhode Island employees who do not have access to a plan through their employer,” says Taylor.
“The state must stop taxing Social Security benefits,” says Taylor. “We are one of 9 states that still tax these benefits. We encourage legislators to keep more money in the pockets of older Rhode Islanders by eliminating the state tax on Social Security,” she says.
“Lastly, we must reframe how we think about housing as we grow older, and Accessible Dwelling Units (ADUs) are part of the equation,” adds Taylor, urging the General Assembly to pass legislation providing housing options that are suitable for differing incomes, ages, and life stages. “ADUs are one way to accomplish this goal,” she notes.
This budget is an important step forward in helping our industry, says James Nyberg, president, and CEO of LeadingAge Rhode Island, a nonprofit representing providers across the long-term care spectrum from nursing facilities to home and community-based providers. “We appreciate Governor McKee and his staff recognizing our concerns and providing an infusion of funds across multiple settings to support older Rhode Islanders wherever they call home, their families, and our dedicated workforce,” he adds. This includes the $10 million in stopgap funds to help nursing homes in critical financial distress as they await their permanent rate adjustment effective October 1.
According to Nyberg, the October adjustment also included in the budget is expected to provide over $60 million in funding to help nursing homes address workforce challenges, the dramatically increased costs of operating their business, and remain financially viable. “We cannot lose any more nursing homes and hopefully this budget will help mitigate that well-documented threat,” he says.
Similarly, the budget includes the phase-in of rate increases for assisted living residences and adult day providers, per the OHIC recommendations, to support these providers, consumers, workers, and families,” says Nyberg. “We also hope the proposed housing bond will help address the shortage of safe and affordable housing for seniors, the lack of which was highlighted in the Long Term Care Coordinating Council’s recent report entitled “Meeting the Housing Needs of Rhode Island’s Older Adults and Individuals with Chronic Disabilities and Illnesses,” he adds.
“While there are financial and other challenges that persist, we look forward to working with the Administration and the General Assembly to advance these and any other initiatives to support our long-term care providers, those for whom they care, and their workforce,” says the nonprofit executive director.
Governor’s budget doesn’t adequately address Seniors’ needs
While aging groups recognize Gov. McKee’s funding provisions that will benefit older Rhode Islanders, one aging advocate calls on the House Finance Committee to beef up funding for seniors in its budget.
“Once again, the senior population of Rhode Island is the fastest growing demographic in the state, and the most neglected,” charges Susan Sweet, former state associate director of the Department of Elderly Affairs and an advocate for seniors facing hardships and low-income difficulties. “The Governor McKee Budget provides no relief for seniors in the proposed 2025 spending plan other than a small gift to nursing homes that may help that senior care industry and a small increase of $200,000 statewide for dividing up among R.I. Senior Centers,” she says.
According to Sweet, seniors receive nothing in the budget other than a proposed tax reduction of “pension and annuity income” to begin in calendar year 2025. In other words, nothing for this year. She notes that the current exemption would be raised from $20,000 to $50,000 while the state remains currently only 9 of 50 states that tax Social Security and a minority of states that tax retirement pensions.
“There is also not one cent for retirees who had their pensions frozen in 2011 and have been stripped of their contracted pension benefits of a Cost of Living Adjustment (COLA) each year which they were required to sign and to contribute to from their pay each year of employment,” she says.
“Just down the road in our neighboring state of Massachusetts, there is no state income tax for Social Security or pensions. Their proposed budget includes a new $2,400 per senior payout for housing assistance, rental, or ownership costs,” says Sweet. During the State of the Commonwealth speech just one day after RI Governor McKee touted his Team RI game plan, a representative of the (Massachusetts) Senior Action advocacy group was invited and recognized as a leading voice in enabling seniors to stay in their homes with cash assistance from the state, she noted.
As the founder of the R.I. Minority Elder Task Force which provides financial assistance to poor RI elders in dire circumstances, Sweet regularly sees the neglect of seniors without adequate resources for the basic needs of life. “This is not a senior-friendly state, and this is not a senior friendly budget,” she states.
Expect aging groups and advocates to gear up to push for their senior legislative priorities in the upcoming months. The budget debate now begins.
To listen to Gov. McKee’s State of the State Address on the FY 2025 Budget, go HERE.
Details of Gov. McKee’s FY 2025 Budget. Go HERE.
To read Gov. McKee’s FY 2025 budget proposal (H 7225), go HERE.
Path to an “age-friendlier” budget
Published in RINewsToday on June 5, 2023
After a 47:10 minute meeting on Friday night, the House Finance Committee approved a $14 billion budget for the 2024 fiscal year that commits funding toward addressing the housing crisis (top priority), supports business development and makes education funding more equitable while limiting the use of one-time revenue to one-time expenditures.
The passed budget reflects the May revenue estimate that was $61.2 million lower than projected last November.
On June 2, 2023, the budget passed on a partisan vote of 13-3, sending the budget bill (2023-H 5200A) to the full House of Representatives, which is slated to take it up June 9 at 2:30 p.m. Changes could be made.
Hammering Out a Compromised Budget
At a news conference held on Friday at 3:30 p.m. before the vote, House Speaker K. Joseph Shekarchi (D-Dist. 23, Warwick) compared the politics of hammering out the state budget proposal to Democratic and GOP leadership making a deal to avoid a national default earlier this week. “Nobody, including me and everyone else here, got everything they wanted,” he said, noting that the state budget required “compromise.”
“Our goal with this budget is to support Rhode Islanders’ needs while responsibly preparing for our future. Our top priority, of course, is addressing our housing crisis, and we have worked hard, in collaboration with Governor McKee and our colleagues in the Senate, to identify the most effective ways we can direct the funding we have toward solutions that will help create more affordable housing access. This budget also strengthens our efforts to provide educational opportunities in K-12 and higher education and supports businesses, working Rhode Islanders, retirees and those struggling to meet their families’ basic needs,” said Shekarchi, in a statement announcing the House Finance Committee’s passage of the budget.
“At the same time, we are being realistic. Given the end of the federal funding related to the pandemic, we need to plan not only for next year, but for the following years, when we are not going to have the level of revenue we’ve been fortunate enough to have for the past few years. We are spending our remaining federal COVID funding and our available revenue on one-time investments rather than creating long-term commitments that we can’t sustain,” he said.
Adds Marvin L. Abney (D-Dist. 73, Newport, Middletown), chairman of the House Finance Committee: “This budget was carefully crafted so that our residents, particularly our most vulnerable, retain the supports and assistance that they and their families need, so that our businesses have the ability and opportunity to grow, and so that Rhode Island is situated to withstand a very possible financial downtown that will affect both our state and national economies. Responsible, compassionate and thoughtful decisions were made to create a budget that will benefit all Rhode Islanders and this budget positions the state to be as competitive as possible into the future.”
Taking a Look at Aging Programs and Services
“I am extremely pleased the budget passed by the House Finance Committee contains important funding that will benefit seniors as well as older adults with disabilities,” says Maureen Maigret, chair of the Aging in Community Subcommittee of Rhode Island’s Long-Term Care Coordinating Council and policy consultant and board member of the Senior Agenda Coalition of RI. “The Office of Healthy Aging (OHA) will receive an additional $250,000 in general revenue for the Aging and Disability Resource Center (ADRC). The ADRC provides counseling about services and benefits and assistance with the application process. Advocating to strengthen the ADRC (called the POINT) was a high priority for the Senior Agenda Coalition of RI and the Aging in Community Subcommittee of the Long Term Care Coordinating Council,” says Maigret.
According to Maigret, this is the first time that ADRC will receive state funds. To date, it has operated with limited federal dollars and too many persons are not aware of the program. The state funding can be matched by federal Medicaid funds. “ADRC services are critically important for older adults, persons with disabilities and family caregivers, as they attempt to find appropriate services and navigate a sometimes-fragmented system of care, says Maigret.
Maigret says that the budget also adds funds to support two new staff positions for OHA’s protective services unit to deal with increasing reports of elder abuse and exploitation. OHA’s Adult Protective Services received over 6,000 calls last year. The additional funding for these positions will ensure that reports are investigated in a timely manner and protect older adults at risk of abuse and neglect.
Other notable additions to the budget include an increase in the Personal Needs Allowance (PNA) for nursing home residents on Medicaid to $75/month (from $50.) This amount had not been adjusted since 1999, says Maigret noting that the additional funding will help thousands of nursing home residents pay for such items as haircuts, clothing and, telephone service.
“The House Finance Committee also added $250,000 to increase funding for the Livable Home Modification grant program to $0.8 million,” says Maigret, noting that the program helps pay for costs of support home modifications and accessibility enhancements to allow individuals to remain in community settings. And of course, the funds dedicated to addressing housing affordability although not specific to the older population will benefit them,” adds Maigret. “Overall, these budget additions and the additional funds for community senior services and Meals on Wheels proposed by the Governor demonstrate a continued commitment on the part of our state leaders to address the needs of our growing older population,” she says.
The budget didn’t reinstate the retiree Cost of Living Adjustments (COLAs) eliminated in 2011. “Once again, retired state workers, teachers, and municipal retirees who are part of the state retirement system have been shown how little they are valued by state legislators”, comments Susan Sweet, a former state associate director of elderly affairs and an advocate for low-income elders. “Although there were many bills in to restore the COLA or at least provide a token payment to these retirees, it appears that no funds at all are being directed towards that purpose. This is a great disappointment to so many folks who faithfully performed their duties and were stripped of their promised pensions. No wonder that teachers and government workers are reluctant to spend their career lives in the public sector” she states.
Is Proposed House Budget “Age Friendly” ?
Maigret believes that the state has taken some positive steps toward becoming “age friendly” especially if we think of age-friendly with an intergenerational lens. Items that address children and youth such as expanded tuition assistance of Rhode Island colleges are important. “However, we still have a long way to go in many of the domains for age friendliness,” she notes, “especially in the area of economic security for older adults as many live with income less than $25,000 relying mostly on fixed incomes.”
Maigret calls on the Rhode Island General Assembly to fund mini-grants to communities to incentivize them to “look at their comprehensive plans with age-friendly lens.”
Here is the link to the bill to establish the budget:
Here is the link to the entire budget and every article (as well as how it compares to the budget as submitted by the Governor in January): https://www.rilegislature.gov/Budget/SitePages/FY24.aspx.
Here is a link to a press release which contains a summary of the highlights of the budget:
To watch the House Finance Committee meeting, go to https://ritv.devosvideo.com/show?video=defebab838c1&apg=52ab780b.
Herb Weiss 